Long-Term Clinical Outcome and Survival after Pylorus-Preserving Gastrectomy

Abstract

Pylorus-preserving gastrectomy (PPG) was introduced as a function preserving and minimally-invasive surgery for early gastric cancer (ECG). We investigated the long-term clinical and oncological outcomes of the procedure. A total of 433 patients who underwent PPG between 1993 and 2009 were assessed retrospectively. The accuracy of the preoperative diagnosis of EGC was 93.1%. The incidence of lymph node metastasis was 3.7%. The median follow-up period was 77 (9-201) months. The overall 5-year survival rate was 96.6%. Three patients with advanced cancer developed recurrence and died. Thirteen patients developed a second primary gastric cancer in the remnant stomach. Four patients were treated by endoscopic resection, and nine underwent gastrectomy all with curative intent. The incidence of regurgitation and gastric-fullness at 5 years after PPG were 6.1% and 1.5%. Endoscopic findings of residual food, gastritis, bile reflex and reflux esophagitis were 19.1%, 11.0%, 3.0%, 10.0%, respectively. The mean relative body weight recovered up to 94.0% of that prior to surgery after 1 year and maintained. PPG is a safe operative procedure for patients with EGC. It is important to improve the accuracy of preoperative diagnosis, and patients should be carefully followed-up to detect remnant stomach cancer.